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FOR OFFICE TUSE: r�Q M, APPLICATION FOR SANITATION PERMIT Permit No. -1-7,7 Z ----------------- --------------------------------------- ------------------ ------ ---------------z.-_ ----- -- (Complete in Duplicate) Date Issued ----------------------------- ------------- This Permit Expires I Year From Date Issued 001-x- -------------- Applicafion is hereby made to the San I Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549'—, fQ9 SAj LSCA LO ---- -------------L4- W&H------------- A------------- --- ON----- --------- JOB ADDIRESS' AN LOCA&SC. ------ Q1>Q .A --------------------------------- Phon ----------- Owner's Name----------Ll --------t-3 e.........P 1 4.1 - Address----------PQ,--- 0-x---------...7-------------------it�__ __CAI_Q_Al----------------------- ------------------------------------------- ---------------- tv I Contractor's Name----70----EIP------J)F--7-F-_R M__iN-X-----b-----------ii is ------------------ ---------------------------------- Phone........_A'•.- will serve: Residence E] Apartment House [] Commercial Trailer Court E] Motel [5, Other E] Number of living units.- Number of bedrooms 7Trrrn_ Number of baths.--I---- Lot size -----A-C.-F,EA_CT -------------------- Wafer Supply: Public system ❑ Community sy "'m F] FrivateJ2--tepfh to Water Table3�K ff. i Character of soil to a depth of 3 feet: Sand ?Gravel [] Sandy Loam El Clay Loam E] Clay Kdoba El Hardpan ❑ Previous Application Made; (if yes,date--------------- No P111, New Construction: Yes ff No 0 FH,A/\A?Yes E] No,� TYPE OF INSTALLATION AND SPECIFICATIONS: m within-200 feet..)--` ftiNcleptic-tWAVJr-ii6spo�1 "er 4teid;if sewer-is-available w t�. Seo?,,Toa*�nk: j_-,Distance fr�6m nearest well---25W-----Distance from foundation__.:ji�__�_]_.Matkial (WIV-Owk' -------- --------Size_3.X_C7_X_57__Liqiuid clepth�------ _-____z&pa No. of comArtment------- Capacity -------- Disposal Field: Distance from nearest"w-ell..:-"D----.DiIP�'e"-�,om' fcu'nAN.%dn.1---1.0--i-J-Distalrice to nearest lot linp,,-5.------- .1 ` 3 ------------r-----Width-' 1_._Distance Number of lines---.-----/__11 --------------7'rl 1.7e A gf h,'Of each k :1 i n9A- - of fre�'ch........-SO...--------------- M_ --a-^f- -2;2— Type of filfd material--'__R0_C_j\,___,Depth of filter material---, _ --A-Tota 11 length--------e-�_ ------------------------ Seepage Pit: Distance to nearest well - -------------------Distan(te from foundation-------------!].D�i!stalnce to nearest lot line----------------- El Number of pits-4-------------------Lining material-----------------------Size: Diameter-!____1'n J---------Depfh-- ___.--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....--------.!-)-.Lining material-----.-___.__._______________.______ 171 Sizer Diametelr-------- - - ----------------- ---- Depth-----------------------------------------------l__!_LiqA Capacity----------------------------gals. Privy: Distance from,ne8.rest,well------M-----------------------------------------Disfance.from.nearesf building__________________________________________ ❑ uiHing------------------------------------- El Distance to nearest lot line----- ----------I--------------------------------------------------------- ------ - Remodeling and/or r?paiiring (describe l:------ --------1-1^1 Z—:------—----- ------------- 'jW&_L_F-----------M- j- - ------ -----------_ -5- - 7h uo-------------- ----------------:;:- j ------------------ ----------i-A ------------- -4f_A�---------------------------------------------I---------------- ------------------------------------------------------------- --------------------:.:------ --------- ----------------------------------------- ---------------------------------------- ---------- -------------- ------------------------------------- ----- I hereby certify that I have pr par I ed this application and ,that fhe"w' o&rkWiIl_*be' ka*ne,464 accordance with San Joaquin County ordinances, Stat and r s rgulafions of the San'Joacluin *a�i7H;-aft7kfOlaii6�," Id I {Signed]__-__.__ - - --------- ----- -------------- ......:-------- --------------------------------(Owner and/or Contractor) ............ ------------------ ----------------------------------- --------------- -4— (Plot plan, showing size of lot, locafi&h of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......17�_R-_O------- --------------------------------------------------------------- DATE----- A" ------------------- REVIEWEDBY------------------------------------------- --------------------1.------------------------------------------------------------ DATE----------------------------- ------------------ BUILDINGPERMIT ISSUED------------------------------------------------------- 7-------------------------------------- DATE--.,------------?f------------------------------------------ Alterations and/or recommendations:------------- ---------- -------------- -------------------------- ---------------------------------_----•-------------------- ----------- ------------- ----------------------- --------------------------------------------I ---------------------------------------------------------- ------------------------------*------------------------------------------------------------------------ -------------------------- --------- --------------------------------------------------------------------------- ------------------------------------------------------- ------ - -------------- - ----- ------- - ------------------------�-------------------------------------------- ----------------------------- ----------------------------------------------------- -- -------- - ------------ -- ---- -- - ---------- -- ----------------------------------------------------------------------- ---- ------_- FINALINSP ----- -------- -- -- --------- Dafe-------------- --------------------------------- SAN JOAOIJIN LOCAL HEALTH DISTRICT 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 363 F.F.CO.